Opioids, diazepam, ketamine 이 발정기 및 임신 흰쥐의 자궁절편 수축에 미치는 영향

임부의 진통시 수반되는 동통(Labor Pain)은 매우 고통스러우며, 산과에서 오래전부터 이를 완화시켜주기 위해 여러가지 방법이 시도되어왔다. 동통을 완화시키기 위한 방법으로 진통제를 사용해 왔으며, Opioids 중 Pethidine, Morphine, Pentazocine이 흔히 사용되어 왔지만 진통제의 자궁수축 억제작용이 분만과정을 지연시킨다고 믿기 때문에 무통분만을 위한 진통제사용이 보편화되지 못하였다. 최근 Silvalingam과 Pleuvry(1985)는 발정기 및 임신 쥐의 자궁절편에 Morphine, Pethidine, Pentazocine을 투여하여 Morphine이 수축빈도를 감소시키는 반면 Pethidine과 Pentazocine은 현저히 증가시킨다고 보고하였다. 따라서 본 연구자는 발정기 및 임신 쥐의 자궁을 적출하여 산과 마취에 흔히 사용되는 Opioids(Morphine, Pethidine, Pentazocine) 및 정맥마취제(Ketamine, Diazepam)을 투여하여 자궁절편의 수축 빈도를 비교 관찰한 결과 다음과 같은 결론을 얻었다. 1. 대조군에서는 시간이 경과함에 따라 자궁절편 수축빈도가 감소하였다. 2. Morphine 투여군에서 약물농도를 증가시킴에 따라 자궁절편 수축빈도가 감소되었으나 대조군에 비해 현저한 차이는 없었다. 3. Pethidine 및 Pentazocine 투여군에서는 약물농도를 증가시킴에 따라 자궁절편 수축빈도가 대조군에 비해 현저히 증가되었다. 4. Diazepam 투여군에서는 약물농도가 증가됨에 따라 자궁절편 수축빈도가 대조군에 비해 현저히 감소되었다. 5. Ketamine 투여군에서는 농도가 증가됨에 따라 자궁절편 수축빈도가 감소되었으나 대조군에 비해 현저한 차이는 없었다. 6. 각 약물투여와 동시에 CaCl_2 0.5mM/100ml를 첨가한 군은 약물 단독투여군에 비해 유의한 차이를 나타내지 않았다. 7. 발정기 자궁절편과 임신 자궁절편의 수축빈도를 각 군에서 비교한 결과 대조군, Morphine 투여군, Pethidine 투여군, Pentazocine 투여군에서 현저한 차이를 나타냈다. ; Opiates have been used as analgesics in obstetrics since the Babylonians. Since that time, a wide variety of opiates have been employed in an attempt to provide analgesia for childbirth. The effect of opioids on uterine contractility is of considerable interest. Morphine caused a concentration-dependent decrease in the frequency of contraction of estrous uterus. In contrast, both pethidine and pentazocine enhanced the contraction rate. The pregnant uterus showed little response to morphine, but exhibited enhanced response to the stimulant activity of both pethidine and pentazocine. It has long been recognized that the tension development of uterine muscle is largely dependent on intracellular Ca^2+ pools. Smooth muscle contraction is initiated by depolariation-induced calcium entry into the myopasm through voltage-dependent calcium channels. The spontaneous or KCI-induced tension development in isolated uterine smooth muscle is reduced by lowering the calcium ion(Ca^2+ ) concentration of the bathing medium. In our study, the effect of morphine, pethidine and pentaocine on estrous and pregnant uterine activity, and the effect of extracellular calcium on opiates induced uterine motility have been examined in the rats, in vitro. The following results were obtained; 1. The frequency of contraction of the estrous and pregnant rat uteri in the control group decreases gradually with time. 2. Morphine caused a concentration-dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri, but it was not significant. 3. Pethidine and pentazocine caused a concentration-dependent increase in the frequency of contraction of the estrous and pregnant rat uteri. 4. Diazepam caused a concentration-dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri. 5. Ketamine caused a concentration-dependent decrease in the frequency of contraction of the estrous and pregnant rat uteri, but it was not significant. 6. Addition of CaCl_2 to the Krebs-Henseleit solution did not make any signicant change in the result. 7. According to the condition of estrous and pregnant rat uteri, the change of contraction frequency was statistically significant in control, morphine, pethidine and pentazocine group.논문개요 ------------------------------------------------------------- ⅷ Ⅰ. 서론 ------------------------------------------------------------- 1 Ⅱ. 실험재료 및 방법 ------------------------------------------------- 3 A. 실험동물 및 실험동물군 ------------------------------------------- 3 B. 적출 자궁절편 ---------------------------------------------------- 3 C. 사용된 영양액 ---------------------------------------------------- 4 D. 약물투여 방법 및 실험대상군 -------------------------------------- 5 E. 통계학적 분석 ---------------------------------------------------- 7 Ⅲ. 실험성적 --------------------------------------------------------- 8 A. 발정기 자궁절편의 수축빈도에 미치는 각 약물의 영향 --------------- 8 B. 임신자궁절편의 수축빈도에 미치는 각 약물의 영향 ------------------ 14 C. 각 약물군에서 발정기 자궁절편과 임신자궁절편의 수축빈도의 차이점 ----------------------------------------------------------- 24 Ⅳ. 고안 ------------------------------------------------------------- 35 Ⅴ. 결론 ------------------------------------------------------------- 40 참고문헌 ------------------------------------------------------------- 41 영문초록 ------------------------------------------------------------- 4

Changes in the level of serum potassium following administration of succinylcholine in patients with closed head injury

Succinylcholine은 탈분극성 근이완제로서 임상마취에서 기관내삽관을 위한 단기간의 근이완목적으로 널리 이용되고 있는 약물이다. Succinylcholine 투여로 근섬유연축, 근육통, 안압상승, 위내압상승 및 혈청K^(+)치증가등의 부작용이 일어나는데 특히 임상적으로 문제가 되는 것은 혈청K^(+)치증가로 인하여 서맥 및 부정맥이 초래되고 심지어는 심정지까지 일으킨다는 점이다. 화상환자, 심한 외상환자, 척추장애환자, 말초신경손상 및 뇌염으로 인한 뇌손상환자에서는 혈청K^(+)치 증가가 현저하다. 따라서 저자는 뇌손상(closed head injury)을 받은 환자에 Succinylcholine 투여에 의한 혈청K^(+)치 증가에 대해서 국내보고가 없어 이에 대한 연구를 시행하였다. 이화여자대학교 의과대학 마취과학교실에서 전신마취하에 기관내삽관후 수술을 시행한 60명의 환자를 대상으로 하였으며 제1군을 뇌손상(closed head injury) 받지 않은 환자 20명, 제2군을 뇌손상후 24시간내에 개두수술을 받은 환자 20명, 제3군을 뇌손상후 10-90일이 경과하여 개두수술을 받은 환자 20명으로 나누었으며, Succinylcholine주입후 2분, 4분, 6분, 10분에 혈청 K^(+)치측정및 심전도를 관찰하여 다음과 같은 결론을 얻었다. 1. 제 2.3군에서 Succinylcholine 투여후 시간경과에 따른 혈청 K^(+)치변화는 4분에 최대치에 이르렀고 6분부터는 점차 감소하였으며 통계학적으로 유의하였다.(P<0.001) 2. 제1군에서보다 제2, 3군에서 혈청K^(+)치증가가 현저하였으며 각 군간에 차이는 통계학적으로 유의하였다.(제1군과 제2군, P<0.05 ; 제2군과 제3군, P<0.001) 3. 제2, 3군에서 의식상태에 따른 최대혈청K^(+)치의 증가는 약간 있었으나 통계학적으로 유의하지 않았다. 4. Succinylcholine 투여시 심전도이상 소견은 91.7%에서 나타났으며, 제1, 2군에서 동성빈맥이 50%이상으로 수위를 차지하였고 제3군에서는 tall Twave가 40%를 차지하였다.;Succinylcholine, the short acting depolarizing muscle relaxant, is commonly used for endotracheal intubation. Succinylcholine induced hyperkalemia has been reported in patients with severe burn, massive trauma, spinal cord injury, some neuromuscular diseases, and cerebral damage. In present study, the serum potassium levels and ECG changes following intravenous injection of succinylcholine in three groups were investigated (group Ⅰ; the patients without head injury, group Ⅱ; the patients with head injury in 24 hours, and group Ⅲ; the patients with head injury in 10-90 days). The results were as follows: 1. The serum potassium levels increased significantly at 4 minutes, slightly decreased at 8 minutes and 10 minutes in group Ⅱ and Ⅲ (p< 0.001). 2. The serum potassium levels (peak change ratio) were higher in group Ⅱ and Ⅲ than group Ⅰ (between group Ⅰ and Ⅱ, p<0.05; between group Ⅱ and Ⅲ, p<0.001). 3. There were no significant differences between the maximal increase of K^(+) according to the degrees of consciousness. 4. Abnormal ECG finding following intubation appeared in fifty-five cases (91.7%). The majority were sinus tachycardia in group Ⅰ and Ⅱ and insignificant tall T wave in group Ⅲ.논문개요 = ⅴ Ⅰ. 서론 = 1 Ⅱ. 연구대상 및 방법 = 3 A. 연구대상 = 3 B. 연구방법 = 3 Ⅲ. 연구성적 = 6 A. 각군별 시간경과에 따른 혈청K^(+)치의 변화 = 6 B. 각군별 혈청K+치의 최고증가율 = 9 C. 의식정도에 따른 혈청K+치의 변화 = 10 D. Succinylcholine 투여에 따른 심전도의 변화 = 11 Ⅳ. 고찰 = 12 Ⅴ. 결론 = 15 REFERENCES = 16 ABSTRACT = 2

Survey of Anxiety in Ordinary Workers and Doctors Regarding Sedative Use during Endoscopic Examination in the Seoul Metropolitan Area

Background/Aims: Sedative use is common in endoscopic examinations. The anxiety regarding sedative use may be different between doctors and nonmedical individuals. Methods: A questionnaire survey was conducted by a research company (DOOIT Survey), and responses were collected from 649 doctors and 1,738 individuals who perform typical jobs in nonmedical fields. In this study, these ordinary workers are considered to represent nonmedical individuals. Anxiety was measured using a 5-point Likert scale. Results: The nonmedical individuals exhibited more anxiety regarding the sedative use than the doctors. Age <40 years (odds ratio [OR], 2.27; p<0.001), female sex (OR, 1.62; p=0.002), experience of an adverse event (OR, 1.79; p=0.049), and insufficient explanation (OR, 2.05; p<0.001) were the significant factors that increased the anxiety of the nonmedical individuals. The doctors who experienced a sedative-related adverse event reported increased anxiety compared with the doctors who did not report this experience (OR, 1.73; p=0.031). Conclusions: Anxiety regarding sedative use during an endoscopic examination was significantly different between doctors and non-medical individuals. A younger age, female sex, an adverse event, and insufficient explanation affect the anxiety of nonmedical individuals. An adverse event also affects the anxiety of doctors

The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy

Background: Several methods are performed to control the pain after a laparoscopic cholecystectomy. Recently, the transverse abdominis plane block has been proposed to compensate for the problems developed by preexisting methods. This study was designed to evaluate the effect of the ultrasound-guided transverse abdominis plane block (US-TAP block) and compare efficacy according to the concentration of local analgesics in patients undergoing laparoscopic cholecystectomy. Methods: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. The patients in Group Control did not receive the US-TAP block. The patients in Group B0.25 and Group B0.5 received the US-TAP block with 0.25% and 0.5% levobupivacaine 30 ml respectively. After the general anesthesia, a bilateral USTAP block was performed using an in-plane technique with 15 ml levobupivacaine on each side. Intraoperative use of remifentanil and postoperative demand of rescue analgesics in PACU were recorded. The postoperative verbal numerical rating scale (VNRS) was evaluated at 20, 30, and 60 min, and 6, 12, and 24 hr. Postoperative complications, including pneumoperitoneum, bleeding, infection, and sleep disturbance, were also checked. Results: The intraoperative use of remifentanil, postoperative VNRS and the postoperative demand of rescue analgesics were lower in the groups receiving the US-TAP block (Group B 0.25 and Group B0.5) than Group Control. There were no statistically or clinically significant differences between Group B 0.25 and Group B0.5. No complications related to the US-TAP block were observed. Conclusions: The US-TAP block with 0.25% or 0.5% levobupivacaine 30 ml (15 ml on each side) significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy. Copyright © Korean Society of Anesthesiologists, 2010

Cerebral fat embolism after bilateral total knee replacement arthroplasty

Fat embolism syndrome is a rare and potentially lethal complication most commonly seen in long bone fractures and intramedullary manipulation. The clinical triad of fat embolism syndrome consists of mental confusion, respiratory distress, and petechiae. This study reports a case of cerebral fat embolism syndrome following elective bilateral total knee replacement. After an uneventful anesthesia and initial recovery, the patient developed neurologic symptoms nine hours postoperatively. Copyright © 2010 Korean Society of Anesthesiologists

Clinical comparisons of 0.5% and 0.375% levobupivacaine for ultrasound-guided axillary brachial plexus block with nerve stimulation

Background: In an axillary brachial plexus block (ABPB), where relatively large doses of local anesthetics are administered, levobupivacaine is preferred due to a greater margin of safety. However, the efficacy of levobupivacaine in ABPB has not been studied much. We performed a prospective, double-blinded study to compare the clinical effect of 0.375% levobupivacaine with 0.5% levobupivacaine for ultrasound (US)-guided ABPB with nerve stimulation. Methods: Forty patients undergoing elective upper limb surgery were randomized into two groups: Group I (0.375% levobupivacaine) and Group II (0.5% levobupivacaine). All four main terminal nerves of the brachial plexus were blocked separately with 7 ml of levobupivacaineusing US guidance with nerve stimulation according to study group. A blinded observer recorded the onset time for sensory and motor block, elapsed time to be ready for surgery, recovery time for sensory and motor block, quality of anesthesia, patient satisfaction and complications. Results: There were no significant differences in the time to find nerve locations, time to perform block and number of skin punctures between groups. Insufficient block was reported in one patient of Group I, but no failed block was reported in either group. There were no differences in the onset time for sensory and motor block, elapsed time to be ready for surgery, patient satisfaction and complications. Conclusions: 0.375% levobupivacaine produced adequate anesthesia for ABPB using US guidance with nerve stimulation, without any clinically significant differences compared to 0.5% levobupivacaine. © The Korean Society of Anesthesiologists, 2012

Topographic pattern of the brachial plexus at the axillary fossa through real-time ultrasonography in koreans

Anatomy; Axilla; Brachial plexus; Ultrasonograph

Dexamathasone added to levobupivacaine improves postoperative analgesia in ultrasound guided interscalene brachial plexus blockade for arthroscopic shoulder surgery

Background: The purpose of this study was to evaluate the effect of the addition of 5 mg dexamethasone to 10 ml of 0.5% levobupivacaine on postoperative analgesic effects of ultrasound guided-interscalene brachial plexus block (ISBPB) in arthroscopic shoulder surgery under general anesthesia. Methods: In 60 patients scheduled for arthroscopic shoulder surgery that underwent general anesthesia, ISBPB was preoperatively performed with 10 ml of 0.5% levobupivacaine under the guidance of ultrasound and a nerve stimulator. Patients were randomly allocated to receive the same volume of normal saline (Group I), 5 mg of dexamethasone (Group II), or 1: 400,000 epinephrine (Group III) as an adjuvant to the mixture. A blind observer recorded total analgesic consumption, sleep quality, complication, and patient satisfaction using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, 48 h after the operation. Results: All patients had successful ISBPB and excellent analgesic effects less than VNRS 4 up to discharge time. VNRS in Group II at 12 h and 48 h was statistically much lower than in Group I and III. There were no differences in total analgesic consumption, sleep quality, complications, and patient satisfaction. Conclusions: We conclude that the addition of 5 mg of dexamethasone to 10 ml of 0.5% levobupivacaine in ISBPB showed improvement of postoperative analgesia for arthroscopic shoulder operation without any specific complications. © the Korean Society of Anesthesiologists, 2012